Let us discuss the murderous cell phones stalking our fair land

Cancer and cell phones - I meant to blog about this for some time, since it has long trended among the most read articles at the Times website.

To be charitable, the article did make me go and look up the literature, so that's not a bad thing. In short, however, the Times treatment is irresponsible and fear-mongering.

First, let me remark that the Times article mentions by name a refereed study of cellphones in humans only in the 14th paragraph. And it neglects to mention the multiple studies which have shown no connection.

Now, let's consider the INTERPHONE study referred to in the Times piece (it's one of these with the fake acronyms). It showed no connection between cell phone use and cancers, when all brain cancers are taken together. Now, it's reasonable for them to analyze different cancers separately, since they are of different severity and prevalence. It's not questionable in itself that they looked at an effect on gliomas. However, this effect was not significant. Only when they looked at cell phone use for 10 years or longer did they find an association with gliomas.

Several caveats - screaming sumo-size caveats - were not mentioned in the Times piece. (A science reporter presumably would have read the article.)

1. As far as I can figure out from reading the article, it's a secondary analysis. There was no a priori hypothesis that cell phone use for 10 years would be associated with glioma. Post hoc analyses are suspect - as you know - since data mining is biased. How many associations were fished through and discarded before this positive one was found? There is always a probability of a false positive, so if there were twenty post-hoc associations (properly consigned to an on-line appendix, pace the Times's conspiratorial mutterings), the chance of one positive finding is 5% - just by probability.

2. The association itself is not statistically significant! This is mentioned nowhere in the Times article, but the authors of the study themselves make haste to note this up front, in the abstract - which makes them responsible. I would not call this a hook to hang anyone's hat on.

3. The INTERPHONE study is a case-control study. A big question in any study of this kind is how we are to judge the accuracy of the cases' self reporting. People with cancer are understandably eager to find a cause, and might recall cell phone use out of proportion to the controls. Such recall bias is hard to control for.

4. Even if recall bias is controlled for, the correlation between recollected number of cell phone calls and the actual number of cell calls is not perfect. Heavier cell phone users tend to overestimate the number of calls they have made. In addition, the correlation between subject recall and their actual exposure to electromagnetic frequency is not airtight either.

5. Let's say the effect is real (which I very much doubt by reason of the sumo caveats just mentioned). (This would contradict another case-control study done on the very relationship between gliomas and cell phone use, in 2005, which was negative.) How high should this putative danger even rank on our public-health agenda?  Gliomas are rare.

To quote a 2004 study in the journal Cancer (first thing I could Google): "The incidence rate of central nervous system (CNS) tumors in 2000 was 6.7 per 100,000 persons as reported from the Surveillance, Epidemiology, and End Results (SEER) registry and gliomas account for approximately 51% of all CNS tumors.". Let's say then 3.5 per 100,000 people. or 10,000 cases a year, more or less. Horrible cases to be sure. If cell phone use increased this number to 20,000 cases a year that would be a tragedy, but a tragedy comparable to the million deaths caused yearly by malaria?

6. In toto: bullshit.

Update: but see some second thoughts here.

A case of ... what?

Recently I was staying with relatives, which gave me the chance to read the New York Times in print. It felt old-timey. I chanced upon an article in Lisa Sanders's Cases series, whose tropes can be summarized as follows:

1. Woman faints.

2. The doctors can't figure out what's wrong with her.

3. Bad Doctor says it's all in her head:

A neurologist in New York carefully examined her and her now thick chart and pronounced definitively that there was nothing wrong with her and that she should try to relax and maybe take up yoga.

4. Good Doctor notices a few key features and makes the diagnosis:

Ledereich watched as the patient calmly sat up. “I know what you’ve got!” he told her excitedly. Her sudden collapse looked as if a switch had been thrown and all her muscles just turned off. Ledereich realized that although it looked like syncope, it wasn’t; she hadn’t actually lost consciousness. What she probably had, Ledereich told her, was something called cataplexy, and that meant that she also had narcolepsy.

So far so good. But the treatment didn't cure the attacks:

But for reasons that neither the patient nor her doctors understand, after about six weeks, [the fainting spells] returned. At first, just occasionally. Then almost daily.

Thereafter she is left to do (more or less) what the Bad Doctor suggested: integrate her new diagnosis into her life.

The patient has learned to cope with her unusual condition; she no longer drives. And when she feels the warning signs, she tries to alert those around her to tell them not to worry. She’s part of a small community, andby now, most know her well enough not to call 911.

There are implications left unexplored here. First: that diagnoses can be partially but not entirely therapeutic. As Up To Date says about cataplexy, "these symptoms are often improved by medications." Often, but not always.

Second, that so much hinges on how the diagnosis is conveyed. Bad Doctor indicated that the woman affected with cataplexy "should just relax" - an abrupt and unhelpful direction, but not, for all that, unfounded. There is a connection between anxiety and cataplexy (and other sleep disorders) remarked upon in the literature.

Finally, a question is left unanswered (and unasked) at the end of the piece. What does the patient know that she has? Does she identify with her diagnosis of cataplexy in a way in which she wouldn't identify with a diagnosis of anxiety or other psychiatric disorder? Does the partial failure of GBH to treat her cataplexy at all detract from her trust/confidence in the diagnosis? In short, what does the patient think of all this?

The Times Again Re-Discovers Yiddish

A whole article in the Times about Yankl Ejdelman without mentioning Yugntruf. Still and all, it's a positive piece.

But I can't help myself. Why is Yiddish a "venerable tongue" in the headline? Surely the language is no older than English? And why is it called "the 1,000-year-old amalgam of Hebrew, German and assorted European dialects that was once the lingua franca of Europe’s Jews"?

Amalgam? (You mean, perhaps "language"?) Assorted European dialects? (Maybe "languages"?) Lingua franca? (Rather, "first language"?)

It's almost as if the reporter knew nothing about the topic she was writing on!

Naw.

Medicosocial misfits

I wish David Brooks' column on people with rank-link imbalances (i.e. those with "all of the social skills required to improve their social rank, but none of the social skills that lead to genuine bonding") didn't seem to apply so strongly to a number of people I know in medicine. Unfortunately, success in the profession of medicine requires social rank - but success in the craft of medicine (patient care!) requires genuine bonding.

The Moral Imagination

Steven Pinker's essay on the moral sciences (Adam Smith, anyone?) in the Times is written in the excited tone of a true believer, and I'm a heretic. The claim is that morality is hard-wired into the brain, and that experimental psychology (with its LiteBrite phrenology, the fMRI) is the window into that wiring.

The main problem I have, grosso modo, is lightly touched upon by Pinker about midway through his article where -- in the context of categorizing the moral priorities of various cultures -- he tosses off a brief disclaimer about whether a given anthropologist is a "lumper or a splitter." The implication is that, if one lumps enough, one can find a useful number of moral categories whose distribution can be predicted by presumed psychological laws.

But morality (which Pinker, if you notice, never gets around to defining) is the very art (or science, or discipline-of-thought) of making such distinctions. Recourse to broad generalities of human behavior (that millions of people around the globe tend to respond the same way to a an Internet survey about counterfactual trolley accidents) is not the same thing as discerning the sources - let alone the definition or guiding principle - of morality. That various approved opinions or behaviors are "moralized" (smoking) or "demoralized" (premarital sex) does not mean they are indicators of changing boundaries of morality, merely that high dudgeon is fungible.

Lumping and splitting is particularly tricky when it comes to religion. This is important, because comparative religionists like to lump. I don't know about the details of many religions, but when "the holy ablutions and dietary restrictions of [...] Orthodox Jews" (that 'Orthodox' drives me nuts, but never mind) is taken as an exemplar of the moral categorization "purity," I raise an eyebrow. The same mistake is made here by which Chomsky facilely lumps all languages into the same hard-wired diagram. Which "holy ablutions" are meant exactly? There are a number in the Torah, and they don't all serve the same purpose. The aim of kashrut, in the Biblical worldview, is a vexing question. I think Milgrom has it right with his proposal that the dietary restrictions are a way to separate out the Jewish people in holiness from the nations. But this is a crucial distinction and something different from "purity."

I don't deny that moral psychology is a science that will contribute to our understanding of morality. But definitions, and fine distinctions, make morality a very tangled tissue to see with any scan.

The New York Times discovers Yiddish
Again.

But nicely.